1. CVFD Training – Rescue Operations SFFMA Training Objectives: 9-01.07 – 9-01.09

2. General Background Environments – Rivers – Streams – Canals – Pools – Lakes – Gravel Pits – Oceans – Storm drain systems Causes – Weather changes – Overconfidence – No PFD – Cramps – Submerged debris – Boat collisions

3. General Background Most incidents preventable Essential EMS practices – Know how to swim – Wear a personal flotation device (PFD) – Take basic water rescue course

4. Water Temperature Body cannot maintain temperature in water <92 o F Heat loss occurs 25x faster than in air

5. Water Temperature Immersion can lead to hypothermia Hypothermia can lead to – Inability to self-rescue – Inability to follow simple directions – Inability to grasp line, flotation device – Sudden immersion, laryngospasm, drowning

6. Water Temperature Personal Flotation Devices – Slow heat loss – Less energy expended for flotation Heat Escape Lessening Position (HELP) – Head out of water – Body floating in fetal position – 60% heat loss reduction Huddle together in groups

7. Basic Rescue Techniques REACH THROW ROW GO ALWAYS WEAR YOUR PFD!

8. Moving Water

9. Most dangerous water rescue Requires proficiency in: – Technical rope rescue skills – Crossing moving water – Defensive swimming – Use of throw bags – Shore-based and boat-based rescues – Ability to package patient in water

10. Recirculating Currents Develop as water moves over uniform obstructions (rocks, low head dams) “Hydraulic” forms, moves against flow Recirculating water traps people against object

11. Recirculating Currents DROWNING MACHINE

12. Strainers Partial obstructions that filter water Downed trees, gratings, mesh Creates unequal force across itself People become pinned water’s force

13. Strainers Attempt to swim over object Do NOT put feet on bottom

14. Foot/Extremity Pins Walking in moving water over knee depth ALWAYS is hazardous! Foot, leg may become entrapped Person can be knocked below surface by water’s force Extremity held in place by water’s weight, force

15. Intakes Height is no indication of danger All dams may have recirculating currents Intake grates serve as strainers

16. Moving Water Self-Rescue Avoid entering water except as last resort! Cover mouth, nose Protect head, keep face out of water Do NOT attempt to stand up Float on back, feet pointed downstream Steer with feet, point head toward near shore at 45 o angle Water move slower on inside of bends Look for obstructions Eddies on downside of objects may flow slowly upstream, moving you toward river’s edge

17. Flat Water

18. Type of waterDrownings (%) Swimming pools53% Bath tubs15% Buckets4% Fish ponds, tanks4% Toilets4% Washing machines1% Ocean1-2% TOTAL~83%

19. Factors Affecting Survival Age Position underwater Lung volume PDF use Water temperature Mammalian diving reflex

20. Factors Affecting Survival PFD Use – 89% of all boating fatalities are related to lack of a PFD – PFDs should be worn when working in, on, or near water – Swimming pools, flash floods can be water hazards even in arid areas!

21. Factors Affecting Survival Mammalian Diving Reflex – Water <68 o F – Bradycardia, intense peripheral vasoconstriction – Blood, oxygen shunted to core organs, circulated very slowly Hypothermia – Slows metabolism – Conserves oxygen – Only protective if it occurs BEFORE cardiac arrest occurs

22. Cold Protective Response YOU’RE NOT DEAD UNTIL YOU’RE WARM AND DEAD!

23. Location of Victims

24. In flat water, location of average patient under average conditions = 1.5 x water depth of where he/she went down Example: – Water is 10 feet deep – Patient will be within a circle with a 15 foot radius centered on spot where patient went down

25. Location of Victims In moving water, patients will be within 100 to 150 yards downstream Common locations: – Deep holes – Eddies downstream of large objects – Strainers

26. Rescue vs. Recovery Time submerged Age Physical condition Known/suspected trauma Water temperature Estimated time for rescue/removal

27. In-Water Patient Immobilization Assume cervical injuries in drowning victims until proven otherwise

28. Phase 1: In-Water SMR Splint victim head, neck with arms Roll victim to face-up position Assure open airway Maintain position until cervical collar applied

29. Phase 2: C-collar Application Primary rescuer maintains airway, SMR Second rescuer sizes, applies collar Second rescuer secures patient’s hand to patient’s waist

30. Phase 3: Backboarding Maintain airway and manual SMR Submerge board under patient’s waist Allow board to float up to victim Secure victim with straps

31. Phase 4: Removal Move to extraction point Extricate patient head first Pass from water to rescuers on land Avoid extrication thorough surf Use bystanders who can swim as a breakwater behind patient